Changes of Spasticity across Time in Prolonged Disorders of Consciousness: A Retrospective Study

Abstract

Objectives: In this retrospective study, we investigated how spasticity developed in patients diagnosed with a prolonged DOC over an almost two-year observation period (21 months), and how it related to the patients’ age, gender, time since injury, etiology, level of consciousness, and anti-spastic medications. Methods: In total, 19 patients with a severe brain injury and prolonged DOC admitted to a long-term care facility were included in this study (14 male, age: 45.8 ± 15.3 years, 10 traumatic brain injury, 1.01 ± 0.99 years after brain injury, 11 minimally conscious state vs. 8 vegetative state). Each patient was assessed at admission and then quarterly, totaling eight assessments over 21 months. Spasticity was measured with the Modified Ashworth Scale (MAS) for both upper and lower limbs. The Western Neuro Sensory Stimulation Profile (WNSSP) was administered to assess the level of consciousness. Any other medical and demographic information of interest was obtained through medical records. Linear mixed models were used to assess each variable’s impact on the change of spasticity over time. Results: Significant differences were observed in the evolution of spasticity in patients based on their etiology for the upper limbs [F (7, 107.29) = 2.226; p = 0.038], and on their level of consciousness for the lower limbs [F (7, 107.07) = 3.196; p = 0.004]. Conclusion: Our preliminary results suggest that spasticity evolves differently according to the type of brain lesion and the level of consciousness. Spasticity in DOCs might therefore be mediated by different mechanisms and might have to be treated differently among patients. Future longitudinal studies should be performed prospectively in a bigger cohort and with data collection beginning earlier after brain injury to confirm our results and better understand the evolution of spasticity in this population.

Neck muscle spasticity in patients with disorder of consciousness: a pilot study

“…Indeed, in our cohort, younger age, hemisyndrome, and tetraparesis were potentially important predictors of severer neck muscle spasticity in MCS patients, while severe spasticity was a predictor of worse neurological and functional outcome at discharge in UWS patients, independently of other confounding variables such as sex, age, and the severity of neurological and functional assessment at admission. These findings are in line with a recent retrospective 7 study which suggested that spasticity evolves differently according to the etiology of the brain lesion and the level of consciousness.…”

“…Previous studies examining spasticity in DOC reported a prevalence ranging from 59% to 89%. 5 - 7 , 16 Indeed, spasticity is one of the commonest complications following severe brain injury, due to the broad distribution and extent of brain damage at various levels of the central nervous system (cortical, infra-cortical and spinal). 5 , 6 As expected, we found that UWV patients presented worse CRS-R and GCS scores on admission.…”

“…The existing literature 5 , 6 suggests that patients with altered state of consciousness have an atypical motor pattern due to the widespread nature of the lesions that could affect the nervous system at various levels. In this regard, despite studies describing spasticity of upper and/or lower limbs, 5 , 7 there are no data on neck muscle spasticity in patients with DOC. This lack of knowledge is quite unexpected given the high potential impact on the rehabilitation process and patient quality of life.…”

Neuro-orthopaedic assessment and management in patients with prolonged disorders of consciousness: A review

“…Regarding the evolution of spastic paresis, a recent longitudinal study in patients with prolonged DoC (> 12 month post injury), showed that both the aetiology and the diagnosis seem to influence the development of spasticity over time. Indeed, the authors found that in TBI patients, spasticity (upper limb) tended to increase in a delayed manner compared to non-TBI aetiologies (Winters et al, 2022).…”

“…The main causes of severe motor disabilities in patients with DoC consist of diffuse spastic paresis (Thibaut et al, 2014;Winters et al, 2022;Zhang et al, 2021), commonly associated with pathological postures, such as decortication and decerebration (Dolce et al, 2002). Spastic paresis is often linked to pain perception and hyperpathia, which may impact patients' quality of life (Bargellesi et al, 2018;Thibaut et al, 2014;Zasler, Formisano, & Aloisi, 2022).…”